Provider Demographics
NPI:1871798918
Name:HANDS ON SURGICAL ASSIST INC
Entity type:Organization
Organization Name:HANDS ON SURGICAL ASSIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:RSA-C
Authorized Official - Phone:815-252-7453
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-0309
Mailing Address - Country:US
Mailing Address - Phone:708-534-2168
Mailing Address - Fax:708-328-3668
Practice Address - Street 1:2434 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1038
Practice Address - Country:US
Practice Address - Phone:815-252-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000090246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty